BETHEL FAMILY CLINIC – Federally Qualified Health Center (FQHC), NPI 1124078019

BETHEL FAMILY CLINIC is a healthcare provider. based in Bethel, Alaska. specializing in Federally Qualified Health Center (FQHC). The NPI Number for BETHEL FAMILY CLINIC is 1124078019

Main info

Organization
Name
BETHEL FAMILY CLINIC
NPI
1124078019
Phone
(907) 543-3773
Address
PO BOX 1908
Authorized Official
SUZANNE NIEMI FINANCE
Enumeration Date
11 May 2006
Last Update Date
27 November 2018
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience45
Completeness75
Years active:20State licenses:0Digital endpointsOther names

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Provider Addresses for BETHEL FAMILY CLINIC

  • Bethel Post Office, 1484, Chief Eddie Hoffman Highway, Bethel, Unorganized Borough, Alaska, 99559, United States

    631 MAIN STREET

    BETHEL, AK 995591908

    Phone: (907) 543-3773

    Fax: (907) 543-3545

    Type: Mailing

  • 631, Main Street, Bethel, Unorganized Borough, Alaska, 99559, United States

    BETHEL, AK 995591908

    Phone: (907) 543-3773

    Fax: (907) 543-3545

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2007-08-17

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Past revalidation due date

Earliest CMS due date was 2023-11-30 (922 days ago).

Enrollment records

1

Earliest due date

2023-11-30

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20070817000095OFederally Qualified Health Center (Fqhc)AK2023-11-30

What to do next

  • Verify current status on the CMS Revalidation Lookup Tool immediately.
  • Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
  • Overdue revalidation can lead to deactivation of Medicare billing privileges.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 99559)

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Reviews

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Frequently asked questions

How is BETHEL FAMILY CLINIC identified in CMS data?
CMS-hosted NPPES data lists BETHEL FAMILY CLINIC with NPI 1124078019.
Can I rely on BETHEL FAMILY CLINIC being an active provider?
As of the registry snapshot, BETHEL FAMILY CLINIC is marked active.
What taxonomy line describes BETHEL FAMILY CLINIC?
For research purposes, treat BETHEL FAMILY CLINIC as Federally Qualified Health Center (FQHC) in this dataset. Clinical services aligned with this taxonomy classification.
Where is BETHEL FAMILY CLINIC based?
BETHEL FAMILY CLINIC is tied to Bethel, Alaska in the data we show; additional addresses may exist on the full record.
Why does BETHEL FAMILY CLINIC have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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